Frailty Measure Improves Cost Prediction

The Centers for Medicare & Medicaid Services hierarchical condition category (CMS-HCC) is used to approximate healthcare costs and to determine payment amounts for patients with various clinical comorbid conditions. However, some patients incur higher actual costs than are predicted by the CMS-HCC payment system. Investigators performed a retrospective cohort study (>16,000 Medicare patients) using CMS claims data to compare two cost-prediction strategies: the standard CMS-HCC model alone and the CMS-HCC model plus a claims-based frailty index (CFI) that incorporates functional impairment. Patients were categorized as being functionally robust (46% of patient-years), prefrail (42%), mildly frail (9.5%), or moderately or severely frail (2.5%…